Volume 28, Issue 3 (6-2018)                   J Holist Nurs Midwifery 2018, 28(3): 151-156 | Back to browse issues page


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Asgari P, Bahramnezhad F, Narenji F, Askari M, Shiri M. Comparison of the Effects of Licorice and Aerobic Exercise on the Quality of Life of Postmenopausal Women. J Holist Nurs Midwifery. 2018; 28 (3) :151-156
URL: http://hnmj.gums.ac.ir/article-1-424-en.html
1- PhD Candidate in Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
2- PhD Department of Nursing, Assistant Professor, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. , Bahramnezhad@sina.tums.ac.ir
3- PhD Candidate in Reproductive Health, Department of Midwifery, Instructor, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran.
4- MSc Nursing (MSc.), School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
5- PhD Condidate Biomedical Engineering and Medical Physics Department, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Introduction
Menopause is one of the most important stages of women’s lives and occurs between 45 and 60 years of age; thus, depending on the life expectancy of women, they spend approximately 30 years of their lives in this stage. In this stage, due to a reduction in the levels of ovarian hormones and pituitary gonadotropins, abnormalities occur in the reproductive system, and eventually, menstruation stops [1]. Following menopause, a woman experiences various symptoms, such as reproductive, mental, and psychological problems, sexual dysfunction, anxiety, depression, and isolation [2]. These symptoms may be severe, thus affecting the normal functioning and the Quality of Life (QoL) of the woman [3]. Various studies have reported the negative effect of menopause on the QoL of postmenopausal women and the need for special attention to their QoL [4, 5]. Given that in the next 50 years, demographic change will lead to a dramatic increase in the number of elderly people, an increase in problems related to menopause is expected [6].
Various interventions, such as education, medication, hormone therapy, and traditional medicine, can alleviate the menopausal symptoms and help improve the QoL [7], but all of them have some limitations. For example, hormone therapy, in addition to controlling menopausal symptoms and preventing osteoporosis, causes some complications, such as increased risk of endometrial and breast cancer, nausea, headache, and hot flashes [8, 9]. In this regard, the use of complementary therapies, such as cupping, aromatherapy, acupuncture, and herbal therapy, has now increased. Organs of some herbal plants, or medicinal plants, may contain substances with curative and palliative properties that can be used to treat or relieve human ailments and their symptoms [10]. Geranium leaf, anise extract, red clover, and licorice are among the plant products widely used to control menopausal symptoms. Among these, licorice, the root of Glycyrrhiza glabra, is a phytoestrogenic plant that contains a large amount of estrogen-like compounds that are effective in treating sleep disorders, fatigue, depression, hot flashes, and gastrointestinal disorders observed in menopausal women [11]. It also increases the mental and physical health of postmenopausal women [12]. Although the pseudo-estrogenic property of this plant has been proven in vitro, further clinical research is warranted [13].
Menopausal symptoms can also be alleviated by behavioral approaches, such as participation in aerobic and anaerobic exercises [14], which can treat hot flashes, night sweats, fatigue, and depression [15] and improve sexual desire and physical strength [16]. Performing regular aerobic exercises can improve blood pressure and thus reduce hot flashes in postmenopausal women, in addition to controlling weight and reducing osteoporosis [17]. However, not all postmenopausal women can perform aerobic and anaerobic exercises as some may have cardiovascular diseases or may be in the early stages of osteoporosis [18, 19]. Stojanovska et al. and Ju YH et al. believe that exercise alone can only help postpone menopausal age and not prevent or control menopausal symptoms [20, 21].
Because of increased life expectancy, women spend a large part of their lives (approximately one-third) in menopause [22]. Given the importance of the QoL of postmenopausal women, the many complications of medications used for treating menopausal symptoms, and the lack of any study comparing the effects of these interventions on the QoL of these women, we conducted this study to compare the effects of licorice and physical activity on the QoL of these women.
Materials and Methods
This quasi-experimental, single-blinded research was conducted at a clinic in Arak City, Iran, in 2014. The research population comprised all postmenopausal women referred to the clinic. Minimum sample size was estimated to be 60 postmenopausal women based on the study of Yazdkhasti et al. [23], with a 95% confidence interval, 80% test power, 0.01 Standard Deviation (SD), and 10% margin of error (µ1=113.30±34.45, µ2=138.35±17). Inclusion criteria were as follows: 48-52 years of age and 1-3 years since last menstruation [24]; literate; using cell phone; no chronic disorders, such as diabetes, hypertension, hyperhidrosis, and hypothyroidism; no overectomy/hyseterectomy; no history of depression or psychiatric disorders; and no use of hormonal drugs and cigarettes during the past 6 months and until the end of the study. The exclusion criteria were as follows: experiencing any adverse event during the study, having any musculoskeletal disorder (fractures) that prevents one from performing exercise, and having a disease that requires a new medical prescription.
Study participants were selected using the convenience sampling method when they visited the clinic for monthly or annual examinations or accompanied by one of their relatives. They were then randomly divided into two groups (licorice and exercise) using a random number table. All participants were explained the aims and procedure of the study, and signed informed consent was obtained from them. The licorice group received three tablets of licorice (containing 380 mg of licorice extract; Razak Pharmaceutical Co., Tehran, Iran) daily at three times, i.e. in the morning, noon, and night before the meal(due to the favorable gastrointestinal effects of the plant in treating indigestion, flatulence, heartburn, and constipation), for 4 weeks [25]
Participants were texted by the researcher every day ensure that they were taking the pills. The exercise group performed regular exercises three times a week for 4 weeks. The exercise duration was 40-45 min and comprised 5 min of warm-up, 30 min of continuous walking or jogging, and 5 min of cooling down [26]. The researcher gathered the participants in the park at 10:00 am - 12:00 am to ensure that the exercises were properly performed. The transportation costs of participants were paid by the researcher. Before the intervention and at the end of the fourth week after the intervention, self-reported personal information inventory and the Menopause-Specific Quality of Life (MENQOL) questionnaire were distributed among participants. The MENQOL questionnaire has 26 items, although its original version designed by Hilditch et al. [27] at the University of Toronto, Canada, had 29 items. The validity of the questionnaire was verified, and its reliability was obtained as 0.84 using the Cronbach’s α coefficient. The questionnaire covers vasomotor,psychomotor, physical, and sexual domains. The answers to questionnaire items are rated based on a 3-point scale (1: Mild; 2: Moderate; and 3: Severe). 
Based on the responses, participants were further divided into three groups in terms of their QoL; the “poor QoL” group, comprising participants with a total score of 52-78; the “moderate QoL” group, comprising those with a total score of 26-52; and the “good QoL” group, comprising those with a total score of 0-26. Therefore, low scores were indicative of a high QoL. The obtained data were analyzed in SPSS V. 16 using the Chi-square test, Wilcoxon signed-rank test, ANOVA, and Mann-Whitney U test.
Results
The mean age of women in the licorice and exercise groups were 51.9±2.02 and 51.8±1.76 years, respectively. Most women in the licorice (90%) and exercise (83.34%) groups were housewives. The educational level of most women in the licorice (43.34%) and exercise (46.66%) groups was high school diploma. Further, most women in the licorice (53.34%) and exercise (63.33%) groups reported their income level as fair. No significant difference was observed between the two groups in terms of socio-demographic characteristics (Table 1).
The Mann-Whitney U test results showed no significant difference between the two groups in terms of vasomotor (P=0.095), psychomotor (P=0.572), physical (P=0.847), sexual (P=0.051), and overall (P=0.065) QoL before the intervention (Table 2). The results 1 month after the intervention also showed no significant difference between the two groups in terms of vasomotor (P=0.15), psychomotor (P=0.899), physical (P=0.716), sexual (P=0.209), and overall (P=0.698) QoL.
Discussion
The present study compared the effects of licorice and physical activity on the QoL of postmenopausal women. The results showed no significant difference between the regular exercise program and the consumption of licorice in terms of improvement in the QoL of postmenopausal women in different domains. In addition, the mean scores of the vasomotor, physical, and sychomotor domains of the QoL in both the exercise and licorice groups were indicative of improvement.
Asterand et al. [28] showed that physical exercises are effective in reducing vasomotor symptoms in postmenopausal women. Tartibian et al. [26] also reported that regular aerobic exercise program reduces vasomotor symptoms (hot flashes). According to Daley et al. [19], regular physical exercises, such as aerobic and resistance exercises, can prevent and reduce the physical symptoms of menopause, such as muscle weakness and osteoporosis. Elavsky and McAuley [29] also reported that physical activity increases the QoL of postmenopausal women. Moriyama et al. [30] suggested physical activity as an independent factor in reducing menopausal symptoms and improving the QoL. The results of the present study support these findings. However, Aiello et al. [31] reported that the exercise program in their study was not effective in reducing menopausal symptoms. This discrepancy in findings is probably due to the differences in the type and time of exercise.
Further, the mean scores of the physical, sychomotor, and vasomotor domains of the QoL were significantly different before and after the intervention in the licorice group, but these scores were not significantly different from the corresponding ones in the exercise group. Nahidi et al. [32] showed that licorice decreases the frequency and severity of hot flashes in postmenopausal women. Similar findings have also been reported by other studies [24, 25]. Jeffrey et al. [33] reported positive effects of licorice on the QoL, including the QoL in the sexual domain, of postmenopausal women. By contrast, the findings of the present study showed that the mean score of the QoL in the sexual domain increased after consuming licorice, indicating a decrease in the QoL in this domain. This discrepancy may be related to cultural differences as most Middle Eastern people, especially women, are reluctant to talk about sex and respond properly to related questions; another reason may be that they did not have sexual intercourse in the month after the intervention to report any changes in the sexual domain. An in-depth research in this field can provide a more accurate answer.
Because the interventions in our study were limited to 1 month (due to time constraints), we suggest that further studies be conducted with a longer study period and larger sample size, involving with the measurement of the QoL before and after the interventions. In addition, the effects of the interventions on long-term complications of menopause, such as osteoporosis and cardiovascular diseases, should be investigated. Considering the high incidence of disorders, such as hypertension and depression, in this age group, it is recommended that in collaboration with other medical groups, the effects of licorice be assessed in women with such disorders and the risk of side effects be compared with the healthy groups. In addition, because the main limitation of the study was the absence of a control group for comparisons with the licorice and exercise groups, further study should be conducted with a control group. Nonetheless, the findings of this study suggest that the health and QoL of postmenopausal women can be improved by adopting interventions involving physical activities and/or herbal medicines.
Ethical Considerations
Compliance with ethical guidelines

This research was approved by the Research Center of Arak Medical University, No. 1098 with Ethics Code of 93-163-8 and was registered by the Iranian Registry of Clinical Trials No.IRCT2015031117873N4.
Funding 
This research was financially supported by the Research Center and Deputy of Research and Technology of Arak University of Medical Sciences.
Conflict of interest
No conflict of interest has been declared by the authors.
Acknowledgements
The authors would like to thank the Health Deputy of Arak University of Medical Sciences and Aristotle Health Center who helped us with this study and all women who participated in the study.


References 
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  2. Williams E, Kalilani R, DiBenedetti D, X Z, Fehnel E, Clark R. Healthcare seeking and treatment for menopausal symptoms In the United States. Maturitas. 2007; 58(2):348-58. [DOI:10.1016/j.maturitas.2007.09.006] [PMID]
  3. Kowalcek I, Rotte D, Banz C, Diedrich K. Women's attitude and perceptions towards menopause in different cultures: Cross-cultural and intra-cultural comparison of pre-menopausal and post-menopausal women in Germany and in Papua New Guinea. Maturitas. 2005; 51(3):227-35. [DOI:10.1016/j.maturitas.2004.07.011]
  4. Chedraui P, Blumel JE, Baron G, Belzares E, Bencosme A, Calle A, et al. Impaired quality of life among middle aged women: A multicentre Latin American study. Maturitas. 2008; 61(4):323-29. [DOI:10.1016/j.maturitas.2008.09.026] [PMID]
  5. Forouhari S, Safari Rad M, Moattari M, Mohit M, Ghaem H. The effect of education on quality of life in menopausal women referring to Shiraz Motahhari Clinic in 2004. Journal of Birjand University of Medical Sciences. 2009; 16(1):39-44.
  6. Taherpour M, Sefidi F. [The effectiveness of education on the knowledge and attitude towards menopause symptoms and complications in postmenopausal women (Persian)]. Journal of Zanjan University of Medical Sciences. 2013; 21(84):92-101.
  7. Kumari M, Stafford M, Marmot M. The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms. Journal of Clinical Epidemiology. 2005; 58(3):719-27. [DOI:10.1016/j.jclinepi.2004.09.016] [PMID]
  8. Falahi A, Nadrian H, Mohammadi S, Baghiyani M. [Utilizing the PRECEDE model to predict quality of life related factors in patients with ulcer peptic disease in Sanandaj, Kurdistan, Iran (Persian)]. Payavard-e Salamat. 2009; 3(2):30-43.
  9. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas. 2009; 62(2):153-59. [DOI:10.1016/j.maturitas.2008.12.006] [PMID]
  10. Bahramnezhad F, Nayeri ND, Bassampour SS, Khajeh M, Asgari P. Honey and radiation-induced stomatitis in patients with Head and neck cancer. Iranian Red Crescent Medical Journal. 2015; 17(10):56-60. [DOI:10.5812/ircmj.19256]
  11. Carlson F, Igelo M. Sense of coherence quality of life before coronary artery bypass surgery: Longitudinal study. Journal of Advanced Nursing. 2000; 31(6):1383-92. [DOI:10.1046/j.1365-2648.2000.01408.x]
  12. Bera K. The effect of life style interventions on quality of life and patient satisfaction with health and health care. Journal of Cardiovascular Nursing. 2003; 18(4):319-25. [DOI:10.1097/00005082-200309000-00010]
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  14. Blumel JE, Castelo Branco C, Cordova AT, Binfa LE, Bonilla HJ, Munoz LG, et al. Relationship between psychological complaints and vasomotor symptoms during climacteric. Maturitas. 2004; 49(3):205-10. [DOI:10.1016/j.maturitas.2004.01.011] [PMID]
  15. Hari kaur K. How yoga meditation and yogic lifestyle can help women meet the challenges of pre-menopause and menopause. Sexuality Reproduction and Menopause. 2004; 2(3):169-75. [DOI:10.1016/j.sram.2004.07.011]
  16. Agil A, Abike F, Daskapan A, Alaca R, Tuzun H. Short-term exercise approaches on menopausal symptoms, psychological health, and quality of life in postmenopausal women. Obstetrics and Gynecology International. 2010; 2010: 1-7. [DOI:10.1155/2010/274261]
  17. Quinteiro H, Buzin M, Conti FF, da Silva Dias D, Figueroa D, Llesuy S, et al. Aerobic exercise training promotes additional cardiac benefits better than resistance exercise training in postmenopausal rats with diabetes. Menopause. 2015; 22(5):534-41. [DOI:10.1097/GME.0000000000000344] [PMID]
  18. Almeida SA, Claudio ER, Mengal VF, de Oliveira SG, Merlo E, Podratz PL, Gouvêa SA, Graceli JB, de Abreu GR. Exercise training reduces cardiac dysfunction and remodeling in ovariectomized rats submitted to myocardial infarction. Plos One. 2014; 9(12):31-40. [DOI:10.1371/journal.pone.0115970] [PMID] [PMCID]
  19. Daley AJ, Strokes-Lampard HJ, Mac Arthur C. Exercise to reduce vasomotor and other menopausal symptoms: A review. Maturitas. 2009; 63(3):176-80. [DOI:10.1016/j.maturitas.2009.02.004] [PMID]
  20. Stojanovska L, Apostolopoulos V, Polman R, Borkoles E. To exercise, or not to exercise, during menopause and beyond. Maturitas. 2014; 77(4):318-23. [DOI:10.1016/j.maturitas.2014.01.006] [PMID]
  21. Ju YH, Doerge DR, Helferich WG. A dietary supplement for female sexual dysfunction, Avlimil, stimulates the growth of estrogen-dependent breast tumors (MCF-7) implanted inovariectomized athymic nude mice. Food and Chemical Toxicology. 2008; 46(2):310-20. [DOI:10.1016/j.fct.2007.08.006] [PMID]
  22. Sierraa B, Hidalgo L, Chedrauib P. Measuring climacteric symptoms in an Ecuadorian population with the Greene Climacteric Scale. Maturitas. 2005; 51(3):236-45. [DOI:10.1016/j.maturitas.2004.08.003] [PMID]
  23. Yazdkhasti M, Keshavarz M, Merghati Khoei E, Hosseini AF. [The effect of structured educational program by support group on menopause women’s quality of life (Persian)]. Iranian Journal of Medical Education. 2012; 11(8):986-94.
  24. Abdollahi F, Azadbakht M, Shabankhahi B, Rezaei Abhari F, Mosleminezhad M. [Effect of Glycyrriza glabra on menopousal complications (Persian)]. Journal of Mazandaran University of Medical Sciences. 2006; 16(56):75-82.
  25. Menati L, Siahpoosh A, Tadayon M. [A randomized double blind clinical trial of licorice on hot flash in post-menopausal women and comparison with hormone replacement therapy (Persian)]. Jundishapur Scientific Medical Journal. 2010; 9(2):157-67.
  26. Tartibian B, Sharabiani S, Abbasi A. [Effect of regular aerobic exercise on vasomotor symptoms (hot flashes) in postmenopausal women (Persian)]. Journal of Babol Univesrity of Medical Sciences. 2009; 11(4):36-41.
  27. Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 2008; 61(1-2):107-21. [DOI:10.1016/j.maturitas.2008.09.014] [PMID]
  28. Asterand L, Nedstrand E, Wyon Y, Hammar M. Vasomotor symptoms and QOL in previously sedentary post menopausal women randomized to physical activity or estrogen therapy. Maturitas. 2004; 48(4):97-105. [DOI:10.1016/S0378-5122(03)00187-7]
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  30. Moriyama CK, Oneda B, Bernardo FR, Cardoso CG, Forjaz CLM, Abrahao SB, et al. A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women. Menopause. 2008; 15(4):613–8. [DOI:10.1097/gme.0b013e3181605494]
  31. Aiello E, Erin J, Yasui Y, Tworoge S, Ulrich C, Irwin M, et al. Effect of a yearlong, moderate-intensity exercise intervention on the occurrence and severity of menopause symptoms in postmenopausal women. The Journal of North American Menopausal Society. 2004; 11(4):382-88. [DOI:10.1097/01.GME.0000113932.56832.27]
  32. Nahidi F, Zare E, Mojab F, Allavi Majd H. [The effect of Glycyrriza glabra on the number of night hot flashes postmenopausal women (Persian)]. Journal of Shahid Beheshti University of Medical Sciences. 2010;19(67):21-5.
  33. Jeffrey A, Bruce E, Kris E, Terri B, Steven R. Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study. The Journal of the American Medical Association. 2003; 290(2):207-14. [DOI:10.1001/jama.290.2.207] [PMID]
Article Type : Research | Subject: General
Received: 2015/04/24 | Accepted: 2015/10/11

References
1. Speroff L, Fritz MA. Clinical gynecologic endocrinology and fertility. Lippincott: Williams and Wilkins; 2010. [PMCID] [PMCID]
2. Williams E, Kalilani R, DiBenedetti D, X Z, Fehnel E, Clark R. Healthcare seeking and treatment for menopausal symptoms In the United States. Maturitas. 2007; 58(2):348-58. [DOI:10.1016/j.maturitas.2007.09.006] [PMID] [DOI:10.1016/j.maturitas.2007.09.006]
3. Kowalcek I, Rotte D, Banz C, Diedrich K. Women's attitude and perceptions towards menopause in different cultures: Cross-cultural and intra-cultural comparison of pre-menopausal and post-menopausal women in Germany and in Papua New Guinea. Maturitas. 2005; 51(3):227-35. [DOI:10.1016/j.maturitas.2004.07.011] [DOI:10.1016/j.maturitas.2004.07.011]
4. Chedraui P, Blumel JE, Baron G, Belzares E, Bencosme A, Calle A, et al. Impaired quality of life among middle aged women: A multicentre Latin American study. Maturitas. 2008; 61(4):323-29. [DOI:10.1016/j.maturitas.2008.09.026] [PMID] [DOI:10.1016/j.maturitas.2008.09.026]
5. Forouhari S, Safari Rad M, Moattari M, Mohit M, Ghaem H. The effect of education on quality of life in menopausal women referring to Shiraz Motahhari Clinic in 2004. Journal of Birjand University of Medical Sciences. 2009; 16(1):39-44.
6. Taherpour M, Sefidi F. [The effectiveness of education on the knowledge and attitude towards menopause symptoms and complications in postmenopausal women (Persian)]. Journal of Zanjan University of Medical Sciences. 2013; 21(84):92-101.
7. Kumari M, Stafford M, Marmot M. The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms. Journal of Clinical Epidemiology. 2005; 58(3):719-27. [DOI:10.1016/j.jclinepi.2004.09.016] [PMID] [DOI:10.1016/j.jclinepi.2004.09.016]
8. Falahi A, Nadrian H, Mohammadi S, Baghiyani M. [Utilizing the PRECEDE model to predict quality of life related factors in patients with ulcer peptic disease in Sanandaj, Kurdistan, Iran (Persian)]. Payavard-e Salamat. 2009; 3(2):30-43.
9. Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas. 2009; 62(2):153-59. [DOI:10.1016/j.maturitas.2008.12.006] [PMID] [DOI:10.1016/j.maturitas.2008.12.006]
10. Bahramnezhad F, Nayeri ND, Bassampour SS, Khajeh M, Asgari P. Honey and radiation-induced stomatitis in patients with Head and neck cancer. Iranian Red Crescent Medical Journal. 2015; 17(10):56-60. [DOI:10.5812/ircmj.19256] [DOI:10.5812/ircmj.19256]
11. Carlson F, Igelo M. Sense of coherence quality of life before coronary artery bypass surgery: Longitudinal study. Journal of Advanced Nursing. 2000; 31(6):1383-92. [DOI:10.1046/j.1365-2648.2000.01408.x] [DOI:10.1046/j.1365-2648.2000.01408.x]
12. Bera K. The effect of life style interventions on quality of life and patient satisfaction with health and health care. Journal of Cardiovascular Nursing. 2003; 18(4):319-25. [DOI:10.1097/00005082-200309000-00010] [DOI:10.1097/00005082-200309000-00010]
13. Skidmore-Roth L. Mosby's handbook of herbs & natural supplements. Missouri: Mosby; 2001.
14. Blumel JE, Castelo Branco C, Cordova AT, Binfa LE, Bonilla HJ, Munoz LG, et al. Relationship between psychological complaints and vasomotor symptoms during climacteric. Maturitas. 2004; 49(3):205-10. [DOI:10.1016/j.maturitas.2004.01.011] [PMID] [DOI:10.1016/j.maturitas.2004.01.011]
15. Hari kaur K. How yoga meditation and yogic lifestyle can help women meet the challenges of pre-menopause and menopause. Sexuality Reproduction and Menopause. 2004; 2(3):169-75. [DOI:10.1016/j.sram.2004.07.011] [DOI:10.1016/j.sram.2004.07.011]
16. Agil A, Abike F, Daskapan A, Alaca R, Tuzun H. Short-term exercise approaches on menopausal symptoms, psychological health, and quality of life in postmenopausal women. Obstetrics and Gynecology International. 2010; 2010: 1-7. [DOI:10.1155/2010/274261] [DOI:10.1155/2010/274261]
17. Quinteiro H, Buzin M, Conti FF, da Silva Dias D, Figueroa D, Llesuy S, et al. Aerobic exercise training promotes additional cardiac benefits better than resistance exercise training in postmenopausal rats with diabetes. Menopause. 2015; 22(5):534-41. [DOI:10.1097/GME.0000000000000344] [PMID] [DOI:10.1097/GME.0000000000000344]
18. Almeida SA, Claudio ER, Mengal VF, de Oliveira SG, Merlo E, Podratz PL, Gouvêa SA, Graceli JB, de Abreu GR. Exercise training reduces cardiac dysfunction and remodeling in ovariectomized rats submitted to myocardial infarction. Plos One. 2014; 9(12):31-40. [DOI:10.1371/journal.pone.0115970] [PMID] [PMCID] [DOI:10.1371/journal.pone.0115970]
19. Daley AJ, Strokes-Lampard HJ, Mac Arthur C. Exercise to reduce vasomotor and other menopausal symptoms: A review. Maturitas. 2009; 63(3):176-80. [DOI:10.1016/j.maturitas.2009.02.004] [PMID] [DOI:10.1016/j.maturitas.2009.02.004]
20. Stojanovska L, Apostolopoulos V, Polman R, Borkoles E. To exercise, or not to exercise, during menopause and beyond. Maturitas. 2014; 77(4):318-23. [DOI:10.1016/j.maturitas.2014.01.006] [PMID] [DOI:10.1016/j.maturitas.2014.01.006]
21. Ju YH, Doerge DR, Helferich WG. A dietary supplement for female sexual dysfunction, Avlimil, stimulates the growth of estrogen-dependent breast tumors (MCF-7) implanted inovariectomized athymic nude mice. Food and Chemical Toxicology. 2008; 46(2):310-20. [DOI:10.1016/j.fct.2007.08.006] [PMID] [DOI:10.1016/j.fct.2007.08.006]
22. Sierraa B, Hidalgo L, Chedrauib P. Measuring climacteric symptoms in an Ecuadorian population with the Greene Climacteric Scale. Maturitas. 2005; 51(3):236-45. [DOI:10.1016/j.maturitas.2004.08.003] [PMID] [DOI:10.1016/j.maturitas.2004.08.003]
23. Yazdkhasti M, Keshavarz M, Merghati Khoei E, Hosseini AF. [The effect of structured educational program by support group on menopause women's quality of life (Persian)]. Iranian Journal of Medical Education. 2012; 11(8):986-94.
24. Abdollahi F, Azadbakht M, Shabankhahi B, Rezaei Abhari F, Mosleminezhad M. [Effect of Glycyrriza glabra on menopousal complications (Persian)]. Journal of Mazandaran University of Medical Sciences. 2006; 16(56):75-82.
25. Menati L, Siahpoosh A, Tadayon M. [A randomized double blind clinical trial of licorice on hot flash in post-menopausal women and comparison with hormone replacement therapy (Persian)]. Jundishapur Scientific Medical Journal. 2010; 9(2):157-67.
26. Tartibian B, Sharabiani S, Abbasi A. [Effect of regular aerobic exercise on vasomotor symptoms (hot flashes) in postmenopausal women (Persian)]. Journal of Babol Univesrity of Medical Sciences. 2009; 11(4):36-41.
27. Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 2008; 61(1-2):107-21. [DOI:10.1016/j.maturitas.2008.09.014] [PMID] [DOI:10.1016/j.maturitas.2008.09.014]
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